Decade Of PTSD Diagnoses Under Review

Army leaders are launching a sweeping, independent review of how the service evaluates soldiers with possible post-traumatic stress disorder following recent complaints that some PTSD diagnoses were improperly overturned.

The Army said Wednesday it will review the diagnoses at all of its medical facilities going back to October 2001. And top Army leaders said they will develop a plan to correct any decisions or policies necessary to make sure that soldiers are receiving the care and treatment they deserve.

The latest reviews were triggered by revelations that the forensic psychiatry unit at Madigan Army Medical Center at Joint Base Lewis-McChord in Washington state may have reversed diagnoses based on the expense of providing care and benefits to members of the military.

Over the past several years, the U.S. military has seen a dramatic spike in the number of PTSD and traumatic brain injury cases as the long and deadly wars in Iraq and Afghanistan dragged on. The services have struggled to find better ways to monitor their troops, identify the often invisible wounds and beef up treatment both at the battlefront and when they return home.

"We owe it to every soldier to ensure that he or she receives the care they need and deserve," said Army Secretary John McHugh, adding that the Army "must ensure that our processes and procedures are thorough, fair and conducted in accordance with appropriate, consistent medical standards."

The Army review will also scrutinize how well soldiers can participate in the system that assesses their ability to receive medical retirements, including whether the appeal process is adequate and whether any nonmedical factors may affect the diagnosis.

There is also a system-wide review being done by the Army inspector general to determine if psychiatrists overturn PTSD diagnoses to save money. The evaluations are the key first step in determining soldiers' disability benefits.

Sen. Patty Murray, D-Wash., who heads the Senate Veterans Affairs Committee, said this is the Army's opportunity to correct the mistakes of the past and ensure that veterans and their families don't need to "wade through an unending bureaucratic process to get proper access to care."

"The bottom line is that the Army needs to fix the inconsistencies we have seen in diagnosing the invisible wounds of war," Murray said. "Out of this review, the Army needs to provide a uniform mental health policy so that service members are given the care they need."

According to Murray, more than 40 percent of the cases since 2007 that involved candidates for retirement had been overturned. During a recent Senate hearing, she said that of the 1,680 patients screened at Madigan, more than 690 had been diagnosed with post-traumatic stress disorder. The psychiatric team there reversed more than 290 of those diagnoses.

On Wednesday, she said that so far, based on the review at Madigan, more than 100 service members have had their PTSD diagnosis returned.

The new Army review will be led by Joseph Westphal, undersecretary of the Army, and Army Gen. Lloyd Austin, the vice chief of staff.

Army officials say soldiers sent to war may be checked up to five times, including before being deployed, during combat, once they return home and six months and a year later. Every soldier returning from deployment completes what the Army calls a post-deployment health assessment and a face-to-face interview with a mental health professional. The Army screens soldiers for depression and PTSD, asking questions to find out about any social stressors, sleep disruption and other problems. Those who are detected as having problems go on to a second phase of screening.

Officials say, however, that no test is considered diagnostically definitive for mental illness in general or PTSD in particular.

More than 134,900 Army personnel were diagnosed with traumatic brain injuries between 2000 and 2011. Of those, 75 percent, or more than 100,000, were diagnosed as having a mild or regular concussion. Army policy calls for every service member involved in a blast, vehicle crash or a blow to the head to be medically evaluated.

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